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Efficacy and safety of early anticoagulation after endovascular treatment in patients with atrial fibrillation. 心房颤动患者血管内治疗后早期抗凝的有效性和安全性。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-03-27 DOI: 10.1136/svn-2022-002082
Yaning Xu, Chengchun Liu, Wei Li, Ximing Nie, Shuhan Huang, Xiaoshu Li, Ya Wu, Wang-Sheng Jin, Jiaojin Jiang, Jun Dong, Yi Yang, Zhiqiang Sun, Wenjun Han, Yanjiang Wang, Liping Liu, Meng Zhang

Background: The timing for initiating anticoagulant therapy in acute ischaemic stroke (AIS) patients with atrial fibrillation who recanalised after endovascular treatment (EVT) is unclear. The objective of this study was to evaluate the effect of early anticoagulation after successful recanalisation in AIS patients with atrial fibrillation.

Methods: Patients with anterior circulation large vessel occlusion and atrial fibrillation who were successfully recanalised by EVT within 24 hours after stroke in the Registration Study for Critical Care of Acute Ischemic Stroke after Recanalization registry were analysed. Early anticoagulation was defined as the initiation of unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) within 72 hours after EVT. Ultra-early anticoagulation was defined if it was initiated within 24 hours. The primary efficacy outcome was the score on the modified Rankin Scale (mRS) at day 90, and the primary safety outcome was symptomatic intracranial haemorrhage within 90 days.

Results: Overall, 257 patients were enrolled, of whom 141 (54.9%) initiated anticoagulation within 72 hours after EVT, including 111 within 24 hours. A significant shift towards better mRS scores at day 90 was associated with early anticoagulation (adjusted common OR 2.08 (95% CI 1.27 to 3.41)). Symptomatic intracranial haemorrhage was comparable between patients treated with early and routine anticoagulation (adjusted OR 0.20 (95% CI 0.02 to 2.18)). Comparison of different early anticoagulation regimens showed that ultra-early anticoagulation was more significantly associated with favourable functional outcomes (adjusted common OR 2.03 (95% CI 1.20 to 3.44)) and reduced the incidence of asymptomatic intracranial haemorrhage (OR 0.37 (95% CI 0.14 to 0.94)).

Conclusions: In AIS patients with atrial fibrillation, early anticoagulation with UFH or LMWH after successful recanalisation is associated with favourable functional outcomes without increasing the risk of symptomatic intracranial haemorrhages.

Trial registration number: ChiCTR1900022154.

背景:血管内治疗(EVT)后再通的急性缺血性中风(AIS)心房颤动患者开始抗凝治疗的时间尚不清楚。本研究的目的是评估房颤AIS患者成功再通后早期抗凝的效果。方法:对在急性缺血性卒中危重症登记研究中,在卒中后24小时内通过EVT成功再通的前循环大血管闭塞和心房颤动患者进行分析。早期抗凝定义为EVT后72小时内开始使用普通肝素(UFH)或低分子肝素(LMWH)。如果在24小时内开始,则定义为超早期抗凝。主要疗效结果为第90天改良兰金量表(mRS)评分,主要安全性结果为90天内出现症状性颅内出血。结果:总共有257名患者入选,其中141人(54.9%)在EVT后72小时内开始抗凝,其中111人在24小时内开始。在第90天,mRS评分向更好方向的显著转变与早期抗凝有关(调整后的普通OR 2.08(95%CI 1.27至3.41))。早期和常规抗凝治疗的患者之间症状性颅内出血具有可比性(调整后OR 0.20(95%CI 0.02至2.18))。不同早期抗凝方案的比较表明与良好的功能结果更显著相关(调整后的普通OR 2.03(95%CI 1.20至3.44)),并降低无症状颅内出血的发生率(OR 0.37(95%CI 0.14至0.94)),成功再通后早期使用UFH或LMWH抗凝与良好的功能结果相关,而不会增加症状性颅内出血的风险。试验注册号:ChiCTR1900022154。
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引用次数: 0
Group 2 innate lymphoid cells resolve neuroinflammation following cerebral ischaemia. 第2组先天性淋巴细胞解决脑缺血后的神经炎症。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-04-18 DOI: 10.1136/svn-2022-001919
Pei Zheng, Yuwhen Xiu, Zhili Chen, Meng Yuan, Yan Li, Ningning Wang, Bohao Zhang, Xin Zhao, Minshu Li, Qiang Liu, Fu-Dong Shi, Wei-Na Jin

Background: Acute brain ischaemia elicits pronounced inflammation, which aggravates neural injury. However, the mechanisms governing the resolution of acute neuroinflammation remain poorly understood. In contrast to regulatory T and B cells, group 2 innate lymphoid cells (ILC2s) are immunoregulatory cells that can be swiftly mobilised without antigen presentation; whether and how these ILC2s participate in central nervous system inflammation following brain ischaemia is still unknown.

Methods: Leveraging brain tissues from patients who had an ischaemic stroke and a mouse model of focal ischaemia, we characterised the presence and cytokine release of brain-infiltrating ILC2s. The impact of ILC2s on neural injury was evaluated through antibody depletion and ILC2 adoptive transfer experiments. Using Rag2-/-γc-/- mice receiving passive transfer of IL-4-/- ILC2s, we further assessed the contribution of interleukin (IL)-4, produced by ILC2s, in ischaemic brain injury.

Results: We demonstrate that ILC2s accumulate in the areas surrounding the infarct in brain tissues of patients with cerebral ischaemia, as well as in mice subjected to focal cerebral ischaemia. Oligodendrocytes were a major source of IL-33, which contributed to ILC2s mobilisation. Adoptive transfer and expansion of ILC2s reduced brain infarction. Importantly, brain-infiltrating ILC2s reduced the magnitude of stroke injury severity through the production of IL-4.

Conclusions: Our findings revealed that brain ischaemia mobilises ILC2s to curb neuroinflammation and brain injury, expanding the current understanding of inflammatory networks following stroke.

背景:急性脑缺血引起明显的炎症,加重神经损伤。然而,控制急性神经炎症解决的机制仍知之甚少。与调节性T和B细胞相反,第2组先天性淋巴细胞(ILC2)是免疫调节细胞,可以在没有抗原呈递的情况下快速动员;这些ILC2是否以及如何参与脑缺血后的中枢神经系统炎症仍然未知。方法:利用缺血性中风患者的脑组织和局灶性缺血小鼠模型,我们表征了脑浸润性ILC2的存在和细胞因子的释放。通过抗体耗竭和ILC2过继转移实验评估了ILC2对神经损伤的影响。使用接受IL-4-/-ILC2s被动转移的Rag2-/-γc-/-小鼠,我们进一步评估了ILC2s产生的白细胞介素(IL)-4在缺血性脑损伤中的作用。结果:我们证明ILC2在脑缺血患者和局灶性脑缺血小鼠的脑组织梗死周围区域积聚。少突胶质细胞是IL-33的主要来源,它有助于ILC2的动员。ILC2的过继转移和扩增减少了脑梗死。重要的是,脑浸润性ILC2通过产生IL-4降低了中风损伤的严重程度。结论:我们的研究结果表明,脑缺血动员ILC2来抑制神经炎症和脑损伤,扩大了目前对中风后炎症网络的理解。
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引用次数: 1
Comparison of carotid endarterectomy and repeated carotid angioplasty and stenting for in-stent restenosis (CERCAS trial): a randomised study. 颈动脉内膜切除术与重复颈动脉血管成形术及支架置入术治疗支架内再狭窄的比较(CERCAS试验):一项随机研究。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-03-27 DOI: 10.1136/svn-2022-002075
Tomáš Hrbáč, Jiří Fiedler, Václav Procházka, Tomáš Jonszta, Martin Roubec, David Pakizer, Daniel Václavík, David Netuka, Tomáš Heryán, David Školoudík

Background and aim: In-stent restenosis (ISR) belongs to an infrequent but potentially serious complication after carotid angioplasty and stenting in patients with severe carotid stenosis. Some of these patients might be contraindicated to repeat percutaneous transluminal angioplasty with or without stenting (rePTA/S). The purpose of the study is to compare the safety and effectiveness of carotid endarterectomy with stent removal (CEASR) and rePTA/S in patients with carotid ISR.

Methods: Consecutive patients with carotid ISR (≥80%) were randomly allocated to the CEASR or rePTA/S group. The incidence of restenosis after intervention, stroke, transient ischaemic attack myocardial infarction and death 30 days and 1 year after intervention and restenosis 1 year after intervention between patients in CEASR and rePTA/S groups were statistically evaluated.

Results: A total of 31 patients were included in the study; 14 patients (9 males; mean age 66.3±6.6 years) were allocated to CEASR and 17 patients (10 males; mean age 68.8±5.6 years) to the rePTA/S group. The implanted stent in carotid restenosis was successfully removed in all patients in the CEASR group. No clinical vascular event was recorded periproceduraly, 30 days and 1 year after intervention in both groups. Only one patient in the CEASR group had asymptomatic occlusion of the intervened carotid artery within 30 days and one patient died in the rePTA/S group within 1 year after intervention. Restenosis after intervention was significantly greater in the rePTA/S group (mean 20.9%) than in the CEASR group (mean 0%, p=0.04), but all stenoses were <50%. Incidence of 1-year restenosis that was ≥70% did not differ between the rePTA/S and CEASR groups (4 vs 1 patient; p=0.233).

Conclusion: CEASR seems to be effective and save procedures for patients with carotid ISR and might be considered as a treatment option.

Trial registration number: NCT05390983.

背景和目的:支架内再狭窄(ISR)是严重颈动脉狭窄患者颈动脉血管成形术和支架置入术后一种罕见但潜在的严重并发症。其中一些患者可能被禁止重复进行经皮腔内血管成形术,无论是否进行支架植入(rePTA/S)。本研究的目的是比较颈动脉ISR患者行颈动脉内膜剥脱术并支架移除(CEASR)和rePTA/S的安全性和有效性。方法:将连续的颈动脉ISR(≥80%)患者随机分为CEASR组或rePTA/S组。介入治疗后再狭窄的发生率、中风、短暂性缺血性发作心肌梗死和死亡30天和1 介入治疗后一年和再狭窄1 对CEASR和rePTA/S组患者干预后一年的情况进行统计评估。结果:本研究共纳入31例患者;14名患者(9名男性;平均年龄66.3±6.6岁)被分配到CEASR组,17名患者(10名男性,平均年龄68.8±5.6岁)被分到rePTA/S组。CEASR组的所有患者均成功移除了颈动脉再狭窄的植入支架。术前30天和术后1天均未记录到临床血管事件 两组干预后一年。CEASR组中只有一名患者在30天内出现介入颈动脉无症状闭塞,rePTA/S组中有一名患者于1天内死亡 干预后一年。rePTA/S组干预后再狭窄(平均20.9%)明显大于CEASR组(平均0%,p=0.04),但所有狭窄均为。试验注册号:NCT05390983。
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引用次数: 1
Blood pressure-related white matter microstructural disintegrity and associated cognitive function impairment in asymptomatic adults. 无症状成年人的血压相关白质微观结构崩解和相关认知功能损伤。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-03-06 DOI: 10.1136/svn-2022-001929
Julián N Acosta, Stefan P Haider, Cyprien Rivier, Audrey C Leasure, Kevin N Sheth, Guido J Falcone, Seyedmehdi Payabvash

Background and objectives: We aimed to investigate the white matter (WM) microstructural/cytostructural disintegrity patterns related to higher systolic blood pressure (SBP), and whether they mediate SBP effects on cognitive performance in middle-aged adults.

Methods: Using the UK Biobank study of community-dwelling volunteers aged 40-69 years, we included participants without a history of stroke, dementia, demyelinating disease or traumatic brain injury. We investigated the association of SBP with MRI diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), intracellular volume fraction (a measure of neurite density), isotropic (free) water volume fraction (ISOVF) and orientation dispersion across WM tracts. Then, we determined whether WM diffusion metrics mediated the effects of SBP on cognitive function.

Results: We analysed 31 363 participants-mean age of 63.8 years (SD: 7.7), and 16 523 (53%) females. Higher SBP was associated with lower FA and neurite density, but higher MD and ISOVF. Among different WM tracts, diffusion metrics of the internal capsule anterior limb, external capsule, superior and posterior corona radiata were most affected by higher SBP. Among seven cognitive metrics, SBP levels were only associated with 'fluid intelligence' (adjusted p<0.001). In mediation analysis, the averaged FA of external capsule, internal capsule anterior limb and superior cerebellar peduncle mediated 13%, 9% and 13% of SBP effects on fluid intelligence, while the averaged MD of external capsule, internal capsule anterior and posterior limbs, and superior corona radiata mediated 5%, 7%, 7% and 6% of SBP effects on fluid intelligence, respectively.

Discussion: Among asymptomatic adults, higher SBP is associated with pervasive WM microstructure disintegrity, partially due to reduced neuronal count, which appears to mediate SBP adverse effects on fluid intelligence. Diffusion metrics of select WM tracts, which are most reflective of SBP-related parenchymal damage and cognitive impairment, may serve as imaging biomarkers to assess treatment response in antihypertensive trials.

背景和目的:我们旨在研究与高收缩压(SBP)相关的白质(WM)微观结构/细胞结构崩解模式,以及它们是否介导SBP对中年人认知表现的影响。方法:使用英国生物银行对40-69岁社区志愿者的研究,我们纳入了没有中风、痴呆、脱髓鞘疾病或创伤性脑损伤史的参与者。我们研究了SBP与MRI扩散指标的关系:分数各向异性(FA)、平均扩散率(MD)、细胞内体积分数(轴突密度的测量)、各向同性(自由)水体积分数(ISOVF)和WM束的定向分散。然后,我们确定WM扩散指标是否介导SBP对认知功能的影响。结果:我们分析了31 363名参与者,平均年龄63.8岁(SD:7.7),以及16 523名(53%)女性。SBP越高,FA和轴突密度越低,但MD和ISOVF越高。在不同的WM束中,SBP升高对内囊-前肢、外囊、上、后放射冠的扩散指标影响最大。在7个认知指标中,SBP水平仅与“流体智力”相关(调整后的p讨论:在无症状的成年人中,较高的收缩压与普遍的WM微观结构崩解有关,部分原因是神经元计数减少,这似乎介导了收缩压对液体智力的不良影响。选择的WM束的扩散指标最能反映收缩压相关的实质损伤和认知障碍,可以作为评估脑脊髓炎的成像生物标志物抗高血压试验中的治疗反应。
{"title":"Blood pressure-related white matter microstructural disintegrity and associated cognitive function impairment in asymptomatic adults.","authors":"Julián N Acosta, Stefan P Haider, Cyprien Rivier, Audrey C Leasure, Kevin N Sheth, Guido J Falcone, Seyedmehdi Payabvash","doi":"10.1136/svn-2022-001929","DOIUrl":"10.1136/svn-2022-001929","url":null,"abstract":"<p><strong>Background and objectives: </strong>We aimed to investigate the white matter (WM) microstructural/cytostructural disintegrity patterns related to higher systolic blood pressure (SBP), and whether they mediate SBP effects on cognitive performance in middle-aged adults.</p><p><strong>Methods: </strong>Using the UK Biobank study of community-dwelling volunteers aged 40-69 years, we included participants without a history of stroke, dementia, demyelinating disease or traumatic brain injury. We investigated the association of SBP with MRI diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), intracellular volume fraction (a measure of neurite density), isotropic (free) water volume fraction (ISOVF) and orientation dispersion across WM tracts. Then, we determined whether WM diffusion metrics mediated the effects of SBP on cognitive function.</p><p><strong>Results: </strong>We analysed 31 363 participants-mean age of 63.8 years (SD: 7.7), and 16 523 (53%) females. Higher SBP was associated with lower FA and neurite density, but higher MD and ISOVF. Among different WM tracts, diffusion metrics of the internal capsule anterior limb, external capsule, superior and posterior corona radiata were most affected by higher SBP. Among seven cognitive metrics, SBP levels were only associated with 'fluid intelligence' (adjusted p<0.001). In mediation analysis, the averaged FA of external capsule, internal capsule anterior limb and superior cerebellar peduncle mediated 13%, 9% and 13% of SBP effects on fluid intelligence, while the averaged MD of external capsule, internal capsule anterior and posterior limbs, and superior corona radiata mediated 5%, 7%, 7% and 6% of SBP effects on fluid intelligence, respectively.</p><p><strong>Discussion: </strong>Among asymptomatic adults, higher SBP is associated with pervasive WM microstructure disintegrity, partially due to reduced neuronal count, which appears to mediate SBP adverse effects on fluid intelligence. Diffusion metrics of select WM tracts, which are most reflective of SBP-related parenchymal damage and cognitive impairment, may serve as imaging biomarkers to assess treatment response in antihypertensive trials.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9298747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impaired glymphatic system as evidenced by low diffusivity along perivascular spaces is associated with cerebral small vessel disease: a population-based study. 一项基于人群的研究表明,沿血管周围空间的低扩散率证明了受损的淋巴系统与大脑小血管疾病有关。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-04-12 DOI: 10.1136/svn-2022-002191
Yu Tian, Xueli Cai, Yijun Zhou, Aoming Jin, Suying Wang, Yingying Yang, Lerong Mei, Jing Jing, Shan Li, Xia Meng, Tiemin Wei, Tao Liu, Yongjun Wang, Yuesong Pan, Yilong Wang

Objective: This study aims to investigate the associations of glymphatic system with the presence, severity and neuroimaging phenotypes of cerebral small vessel disease (CSVD) in a community-based population.

Method: This report included 2219 community-dwelling people aged 50-75 years who participated in the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events cohort. The diffusivity along perivascular spaces based on diffusion tensor imaging (DTI-ALPS index) was measured to assess glymphatic pathway. The presence and severity of CSVD were estimated using a CSVD score (points from 0 to 4) and a modified CSVD score (points from 0 to 4), which were driven by 4 neuroimaging features of CSVD, including white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS), lacunes, cerebral microbleeds. Brain atrophy (BA) was also evaluated. Binary or ordinal logistic regression analyses were carried out to investigate the relationships of DTI-ALPS index with CSVD.

Result: The mean age was 61.3 (SD 6.6) years, and 1019 (45.9%) participants were men. The average DTI-ALPS index was 1.67±0.14. Individuals in the first quartile (Q1) of the DTI-ALPS index had higher risks of the presence of CSVD (OR 1.77, 95% CI 1.33 to 2.35, p<0.001), modified presence of CSVD (odds ratio (OR) 1.80, 95% CI 1.38 to 2.34, p<0.001), total burden of CSVD (common OR (cOR) 1.89, 95% CI 1.43 to 2.49, p<0.001) and modified total burden of CSVD (cOR 1.95, 95% CI 1.51 to 2.50, p<0.001) compared with those in the fourth quartile (Q4). Additionally, individuals in Q1 of the DTI-ALPS index had increased risks of WMH burden, modified WMH burden, lacunes, basal ganglia-EPVS and BA (all p<0.05).

Conclusion: A lower DTI-ALPS index underlay the presence, severity and typical neuroimaging markers of CSVD, implying that glymphatic impairment may interact with CSVD-related pathology in the general ageing population.

Trial registration number: NCT03178448.

目的:本研究旨在探讨社区人群中glymphatic系统与脑小血管疾病(CSVD)的存在、严重程度和神经影像学表型的关系。方法:本报告纳入了2219名50-75岁的社区居民,他们参与了认知障碍和电子烟事件的多血管R评估队列。基于扩散张量成像(DTI-ALPS指数)测量沿血管周围空间的扩散率,以评估glymphatic通路。CSVD的存在和严重程度是使用CSVD评分(0至4分)和改良的CSVD评分来估计的,这是由CSVD的4个神经影像学特征驱动的,包括白质高信号(WMH)、血管周围间隙扩大(EPVS)、血管间隙、脑微出血。还评估了脑萎缩(BA)。采用二元或有序逻辑回归分析,探讨DTI-ALPS指数与CSVD的关系。结果:平均年龄为61.3岁(SD 6.6),1019名参与者(45.9%)为男性。DTI-LPS指数平均为1.67±0.14。DTI-ALPS指数第一个四分位数(Q1)的个体存在CSVD的风险较高(OR 1.77,95%CI 1.33-2.35,P结论:较低的DTI-ALPS指数是CSVD存在、严重程度和典型神经影像学标志物的基础,这意味着在一般老龄人群中,glymphatic损伤可能与CSVD相关病理相互作用。试验注册号:NCT03178448。
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引用次数: 3
Long-term functional outcomes improved with deep brain stimulation in patients with disorders of consciousness. 意识障碍患者的脑深部刺激可改善长期功能结果。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-03-07 DOI: 10.1136/svn-2022-001998
Yi Yang, Qiheng He, Yuanyuan Dang, Xiaoyu Xia, Xin Xu, Xueling Chen, Jizong Zhao, Jianghong He

Background: Deep brain stimulation (DBS) has been preliminarily applied to treat patients with disorders of consciousness (DoCs). The study aimed to determine whether DBS was effective for treating patients with DoC and identify factors related to patients' outcomes.

Methods: Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed. Multivariate regression and subgroup analysis were performed to adjust for potential confounders. The primary outcome was improvement in consciousness at 1 year.

Results: An overall improvement in consciousness at 1 year was achieved in 32.4% (12/37) of the DBS group compared with 4.3% (14/328) of the conservative group. After full adjustment, DBS significantly improved consciousness at 1 year (adjusted OR 11.90, 95% CI 3.65-38.46, p<0.001). There was a significant treatment×follow up interaction (H=14.99, p<0.001). DBS had significantly better effects in patients with minimally conscious state (MCS) compared with patients with vegetative state/unresponsive wakefulness syndrome (p for interaction <0.001). A nomogram based on age, state of consciousness, pathogeny and duration of DoCs indicated excellent predictive performance (c-index=0.882).

Conclusions: DBS was associated with better outcomes in patients with DoC, and the effect was likely to be significantly greater in patients with MCS. DBS should be cautiously evaluated by nomogram preoperatively, and randomised controlled trials are still needed.

背景:脑深部刺激(DBS)已初步应用于治疗意识障碍(DoCs)患者。该研究旨在确定DBS是否对DoC患者有效,并确定与患者预后相关的因素。方法:回顾性分析2011年7月15日至2021年12月31日连续入院的365例多发性硬化症患者的数据。进行多变量回归和亚组分析,以调整潜在的混杂因素。主要结果是1年时意识有所改善。结果:1年时,DBS组的意识总体改善率为32.4%(12/37),而保守组为4.3%(14/328)。完全调整后,DBS在1年时显著改善了意识(调整OR 11.90,95%CI 3.65-38.46,P结论:DBS与DoC患者的更好结果相关,MCS患者的效果可能更大。术前应通过列线图谨慎评估DBS,仍需进行随机对照试验。
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引用次数: 2
Retinal microvascular signs and recurrent vascular events in patients with TIA or minor stroke. TIA或轻度脑卒中患者的视网膜微血管体征和复发性血管事件。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-03-01 DOI: 10.1136/svn-2022-001784
Philipp Klyscz, Thomas Ihl, Inga Laumeier, Maureen Steinicke, Matthias Endres, Georg Michelson, Heinrich J Audebert

Background and purpose: Retinal pathologies are an independent risk factor for ischaemic stroke, but research on the predictive value of retinal abnormalities for recurrent vascular events in patients with prior stroke is inconclusive. We investigated the association of retinal pathologies with subsequent vascular events.

Methods: In a substudy of the Intensified secondary prevention intending a reduction of recurrent events in TIA and minor stroke patients (INSPiRE-TMS) trial, we enrolled patients with recent transient ischaemic attack (TIA) or minor stroke with at least one modifiable risk factor. Primary outcome was the composite of subsequent vascular events. Retinal photographs were taken at baseline and categorised into three different fundus groups by a telemedically linked ophthalmologist.

Results: 722 patients participated in the current study and 109 major vascular events occurred. After multivariable adjustments, we did not find a significant association between fundus categories and risk for subsequent vascular events (HRs for moderate vascular retinopathy and vascular retinopathy with vessel rarefaction in comparison to no vascular retinopathy 1.03 (95% CI 0.64 to 1.67), p=0.905 and 1.17 (95% CI 0.62 to 2.20), p=0.626). In a selective post hoc analysis in patients with diabetes mellitus and hypertension, patients with vascular retinopathy with vessel rarefaction had a higher risk for recurrent stroke (HR 24.14 (95% CI 2.74 to 212.50), p=0.004).

Conclusions: Retinal changes did not predict major subsequent vascular events in patients with recent TIA or minor stroke. Further studies are needed to examine the utility of fundus photography in assessing the risk of stroke recurrence in patients with diabetes mellitus and hypertension.

背景和目的:视网膜病变是缺血性卒中的一个独立风险因素,但对视网膜异常对既往卒中患者复发性血管事件的预测价值的研究尚不确定。我们研究了视网膜病变与随后血管事件的关系。方法:在旨在减少TIA和轻度脑卒中患者复发事件的强化二级预防(INSPiRE TMS)试验的子研究中,我们招募了近期短暂性脑缺血发作(TIA)或至少有一个可改变危险因素的轻度脑卒中的患者。主要结果是随后血管事件的复合。视网膜照片在基线时拍摄,并由远程医学联系的眼科医生分为三组不同的眼底。结果:722名患者参与了本研究,共发生109起重大血管事件。经过多变量调整后,我们没有发现眼底类别与随后血管事件的风险之间存在显著关联(中度血管性视网膜病变和血管稀少的血管性视网膜病的HR与无血管性视网膜疾病的HR相比为1.03(95%CI 0.64-1.67),p=0.905 1.17(95%CI 0.62-2.20),p=0.626)。在糖尿病和高血压患者的选择性事后分析中,伴有血管稀疏的血管性视网膜病变患者复发性卒中的风险更高(HR24.14(95%CI 2.74-212.50),p=0.004)。需要进一步的研究来检查眼底摄影在评估糖尿病和高血压患者中风复发风险中的作用。
{"title":"Retinal microvascular signs and recurrent vascular events in patients with TIA or minor stroke.","authors":"Philipp Klyscz, Thomas Ihl, Inga Laumeier, Maureen Steinicke, Matthias Endres, Georg Michelson, Heinrich J Audebert","doi":"10.1136/svn-2022-001784","DOIUrl":"10.1136/svn-2022-001784","url":null,"abstract":"<p><strong>Background and purpose: </strong>Retinal pathologies are an independent risk factor for ischaemic stroke, but research on the predictive value of retinal abnormalities for recurrent vascular events in patients with prior stroke is inconclusive. We investigated the association of retinal pathologies with subsequent vascular events.</p><p><strong>Methods: </strong>In a substudy of the Intensified secondary prevention intending a reduction of recurrent events in TIA and minor stroke patients (INSPiRE-TMS) trial, we enrolled patients with recent transient ischaemic attack (TIA) or minor stroke with at least one modifiable risk factor. Primary outcome was the composite of subsequent vascular events. Retinal photographs were taken at baseline and categorised into three different fundus groups by a telemedically linked ophthalmologist.</p><p><strong>Results: </strong>722 patients participated in the current study and 109 major vascular events occurred. After multivariable adjustments, we did not find a significant association between fundus categories and risk for subsequent vascular events (HRs for moderate vascular retinopathy and vascular retinopathy with vessel rarefaction in comparison to no vascular retinopathy 1.03 (95% CI 0.64 to 1.67), p=0.905 and 1.17 (95% CI 0.62 to 2.20), p=0.626). In a selective post hoc analysis in patients with diabetes mellitus and hypertension, patients with vascular retinopathy with vessel rarefaction had a higher risk for recurrent stroke (HR 24.14 (95% CI 2.74 to 212.50), p=0.004).</p><p><strong>Conclusions: </strong>Retinal changes did not predict major subsequent vascular events in patients with recent TIA or minor stroke. Further studies are needed to examine the utility of fundus photography in assessing the risk of stroke recurrence in patients with diabetes mellitus and hypertension.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9076111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Characteristics of intracranial plaque in patients with non-cardioembolic stroke and intracranial large vessel occlusion. 非心源性脑卒中和颅内大血管闭塞患者的颅内斑块特征。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-03-13 DOI: 10.1136/svn-2022-002071
Dan Wang, Zi-Yang Shang, Yu Cui, Ben-Qiang Yang, George Ntaios, Hui-Sheng Chen

Objective: To determine the characteristics of intracranial plaque proximal to large vessel occlusion (LVO) in stroke patients without major-risk cardioembolic source using 3.0 T high-resolution MRI (HR-MRI).

Methods: We retrospectively enrolled eligible patients from January 2015 to July 2021. The multidimensional parameters of plaque such as remodelling index (RI), plaque burden (PB), percentage lipid-rich necrotic core (%LRNC), presence of discontinuity of plaque surface (DPS), fibrous cap rupture, intraplaque haemorrhage and complicated plaque were evaluated by HR-MRI.

Results: Among 279 stroke patients, intracranial plaque proximal to LVO was more prevalent in the ipsilateral versus contralateral side to stroke (75.6% vs 58.8%, p<0.001). The larger PB (p<0.001), RI (p<0.001) and %LRNC (p=0.001), the higher prevalence of DPS (61.1% vs 50.6%, p=0.041) and complicated plaque (63.0% vs 50.6%, p=0.016) were observed in the plaque ipsilateral versus contralateral to stroke. Logistic analysis showed that RI and PB were positively associated with an ischaemic stroke (RI: crude OR: 1.303, 95% CI 1.072 to 1.584, p=0.008; PB: crude OR: 1.677, 95% CI 1.381 to 2.037, p<0.001). In subgroup with <50% stenotic plaque, the greater PB, RI, %LRNC and the presence of complicated plaque were more closely related to stroke, which was not evident in subgroup with ≥50% stenotic plaque.

Conclusion: This is the first study to report the characteristics of intracranial plaque proximal to LVO in non-cardioembolic stroke. It provides potential evidence to support different aetiological roles of <50% stenotic vs ≥50% stenotic intracranial plaque in this population.

目的:应用3.0T高分辨率MRI(HR-MRI)确定无主要心脏栓塞源的脑卒中患者大血管闭塞(LVO)近端颅内斑块的特征。方法:我们对2015年1月至2021年7月符合条件的患者进行了回顾性研究。应用HR-MRI评价斑块的多维参数,如重塑指数(RI)、斑块负荷(PB)、富脂坏死核心百分比(%LRNC)、斑块表面不连续性(DPS)、纤维帽破裂、斑块内出血和复杂斑块。结果:在279例脑卒中患者中,LVO附近的颅内斑块在脑卒中的同侧比对侧更常见(75.6%比58.8%,P结论:这是首次报道非心源性栓塞性脑卒中中LVO附近颅内斑块特征的研究
{"title":"Characteristics of intracranial plaque in patients with non-cardioembolic stroke and intracranial large vessel occlusion.","authors":"Dan Wang, Zi-Yang Shang, Yu Cui, Ben-Qiang Yang, George Ntaios, Hui-Sheng Chen","doi":"10.1136/svn-2022-002071","DOIUrl":"10.1136/svn-2022-002071","url":null,"abstract":"<p><strong>Objective: </strong>To determine the characteristics of intracranial plaque proximal to large vessel occlusion (LVO) in stroke patients without major-risk cardioembolic source using 3.0 T high-resolution MRI (HR-MRI).</p><p><strong>Methods: </strong>We retrospectively enrolled eligible patients from January 2015 to July 2021. The multidimensional parameters of plaque such as remodelling index (RI), plaque burden (PB), percentage lipid-rich necrotic core (%LRNC), presence of discontinuity of plaque surface (DPS), fibrous cap rupture, intraplaque haemorrhage and complicated plaque were evaluated by HR-MRI.</p><p><strong>Results: </strong>Among 279 stroke patients, intracranial plaque proximal to LVO was more prevalent in the ipsilateral versus contralateral side to stroke (75.6% vs 58.8%, p<0.001). The larger PB (p<0.001), RI (p<0.001) and %LRNC (p=0.001), the higher prevalence of DPS (61.1% vs 50.6%, p=0.041) and complicated plaque (63.0% vs 50.6%, p=0.016) were observed in the plaque ipsilateral versus contralateral to stroke. Logistic analysis showed that RI and PB were positively associated with an ischaemic stroke (RI: crude OR: 1.303, 95% CI 1.072 to 1.584, p=0.008; PB: crude OR: 1.677, 95% CI 1.381 to 2.037, p<0.001). In subgroup with <50% stenotic plaque, the greater PB, RI, %LRNC and the presence of complicated plaque were more closely related to stroke, which was not evident in subgroup with ≥50% stenotic plaque.</p><p><strong>Conclusion: </strong>This is the first study to report the characteristics of intracranial plaque proximal to LVO in non-cardioembolic stroke. It provides potential evidence to support different aetiological roles of <50% stenotic vs ≥50% stenotic intracranial plaque in this population.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10648047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9101915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Loss of life expectancy due to stroke and its subtypes in urban and rural areas in China, 2005-2020. 2005-2020年中国城市和农村地区因中风及其亚型导致的预期寿命损失。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-10-01 Epub Date: 2023-03-06 DOI: 10.1136/svn-2022-001968
Zixin Wang, Wei Liu, Yi Ren, Chen Zhang, Jia Yang, Lijun Wang, Maigeng Zhou, Peng Yin, Junwei Hao, Qingfeng Ma

Stroke is characterised by high mortality and disability rate in China. This study aimed to explore the temporal trends in years of life lost (YLL) and loss of life expectancy due to stroke and its subtypes in urban and rural areas in China during 2005-2020. Data were obtained from China National Mortality Surveillance System. Abbreviated life and stroke-eliminated life tables were generated to calculate loss of life expectancy. The YLL and loss of life expectancy due to stroke in urban and rural areas at both national and provincial level during 2005-2020 were estimated. In China, the age-standardised YLL rate due to stroke and its subtypes were higher in rural areas than in urban areas. The YLL rate due to stroke showed a downward trend in both urban and rural residents from 2005 to 2020, decreased by 39.9% and 21.5%, respectively. Loss of life expectancy caused by stroke decreased from 1.75 years to 1.70 years from 2005 to 2020. During which, loss of life expectancy due to intracerebral haemorrhage (ICH) decreased from 0.94 years to 0.65 years, while that of ischaemic stroke (IS) increased from 0.62 years to 0.86 years. A slightly upward trend was observed in loss of life expectancy caused by subarachnoid haemorrhage (SAH), from 0.05 years to 0.06 years. Loss of life expectancy due to ICH and SAH was always higher in rural areas than in urban areas, whereas that of IS was higher in urban areas than in rural areas. Rural males suffered the greatest loss of life expectancy due to ICH and SAH, while the highest loss of life expectancy caused by IS was found in urban females. Furthermore, Heilongjiang (2.25 years), Tibet (2.17 years) and Jilin (2.16 years) were found to have the highest loss of life expectancy caused by stroke in 2020. Loss of life expectancy caused by ICH and SAH was higher in western China, while the disease burden of IS was heavier in northeast China. Stroke remains a major public health problem in China, although the age-standardised YLL rate and loss of life expectancy due to stroke decreased. Evidence-based strategies should be conducted to reduce the premature death burden caused by stroke and prolong life expectancy in Chinese population.

在中国,中风的特点是高死亡率和致残率。本研究旨在探讨2005-2020年中国城市和农村地区因中风及其亚型导致的寿命损失年数(YLL)和预期寿命损失的时间趋势。数据来自中国全国死亡率监测系统。生成缩短寿命和中风消除寿命表,以计算预期寿命损失。对2005-2020年全国和省级城市和农村地区因中风造成的YLL和预期寿命损失进行了估计。在中国,农村地区因中风及其亚型导致的年龄标准化YLL率高于城市地区。2005年至2020年,城市和农村居民因中风导致的YLL发病率均呈下降趋势,分别下降了39.9%和21.5%。从2005年到2020年,中风导致的预期寿命损失从1.75岁降至1.70岁。在此期间,脑出血(ICH)导致的预期寿命损失从0.94岁降至0.65岁,而缺血性中风(IS)导致的预计寿命损失从0.62岁增至0.86岁。蛛网膜下腔出血(SAH)导致的预期寿命损失略有上升,从0.05岁上升到0.06岁。农村地区因脑出血和蛛网膜下腔出血而造成的预期寿命损失总是高于城市地区,而IS在城市地区的预期寿命损耗高于农村地区。农村男性因脑出血和蛛网膜下腔出血而遭受的预期寿命损失最大,而城市女性因脑出血而遭受预期寿命损失最高。此外,黑龙江(2.25岁)、西藏(2.17岁)和吉林(2.16岁)在2020年因中风导致的预期寿命损失最高。ICH和SAH导致的预期寿命损失在中国西部较高,而IS的疾病负担在中国东北较重。中风仍然是中国的一个主要公共卫生问题,尽管年龄标准化的YLL率和中风导致的预期寿命损失有所下降。应采取循证策略,以减少中风造成的过早死亡负担,延长中国人口的预期寿命。
{"title":"Loss of life expectancy due to stroke and its subtypes in urban and rural areas in China, 2005-2020.","authors":"Zixin Wang, Wei Liu, Yi Ren, Chen Zhang, Jia Yang, Lijun Wang, Maigeng Zhou, Peng Yin, Junwei Hao, Qingfeng Ma","doi":"10.1136/svn-2022-001968","DOIUrl":"10.1136/svn-2022-001968","url":null,"abstract":"<p><p>Stroke is characterised by high mortality and disability rate in China. This study aimed to explore the temporal trends in years of life lost (YLL) and loss of life expectancy due to stroke and its subtypes in urban and rural areas in China during 2005-2020. Data were obtained from China National Mortality Surveillance System. Abbreviated life and stroke-eliminated life tables were generated to calculate loss of life expectancy. The YLL and loss of life expectancy due to stroke in urban and rural areas at both national and provincial level during 2005-2020 were estimated. In China, the age-standardised YLL rate due to stroke and its subtypes were higher in rural areas than in urban areas. The YLL rate due to stroke showed a downward trend in both urban and rural residents from 2005 to 2020, decreased by 39.9% and 21.5%, respectively. Loss of life expectancy caused by stroke decreased from 1.75 years to 1.70 years from 2005 to 2020. During which, loss of life expectancy due to intracerebral haemorrhage (ICH) decreased from 0.94 years to 0.65 years, while that of ischaemic stroke (IS) increased from 0.62 years to 0.86 years. A slightly upward trend was observed in loss of life expectancy caused by subarachnoid haemorrhage (SAH), from 0.05 years to 0.06 years. Loss of life expectancy due to ICH and SAH was always higher in rural areas than in urban areas, whereas that of IS was higher in urban areas than in rural areas. Rural males suffered the greatest loss of life expectancy due to ICH and SAH, while the highest loss of life expectancy caused by IS was found in urban females. Furthermore, Heilongjiang (2.25 years), Tibet (2.17 years) and Jilin (2.16 years) were found to have the highest loss of life expectancy caused by stroke in 2020. Loss of life expectancy caused by ICH and SAH was higher in western China, while the disease burden of IS was heavier in northeast China. Stroke remains a major public health problem in China, although the age-standardised YLL rate and loss of life expectancy due to stroke decreased. Evidence-based strategies should be conducted to reduce the premature death burden caused by stroke and prolong life expectancy in Chinese population.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10846489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion: data from ANGEL-ACT registry. 联合支架取出器和接触抽吸的机械血栓切除术与单独支架取出器治疗急性大血管闭塞的比较:来自ANGEL-ACT注册中心的数据。
IF 5.9 1区 医学 Q1 Medicine Pub Date : 2023-08-01 Epub Date: 2023-01-31 DOI: 10.1136/svn-2022-001765
Xiaochuan Huo, Dapeng Sun, Mingkai Hu, Raynald, Baixue Jia, Xu Tong, Gaoting Ma, Anxin Wang, Ning Ma, Feng Gao, Dapeng Mo, Zhongrong Miao

Background and purpose: An analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion (LVO) stroke between stent retrieval (SR) alone as a first-line mechanical thrombectomy (MT) technique (SR alone first-line) and concomitant use of contact aspiration (CA) plus SR as a first-line MT technique (SR+CA first-line). The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in China.

Methods: We conducted the present study by using the data from the ANGEL-ACT registry. We divided the selected patients into SR+CA first-line and SR alone first-line groups. We performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes, including successful/complete recanalisation after the first technique alone and all procedures, first-pass successful/complete recanalisation, number of passes, 90-day modified Rankin Scale, procedure duration, rescue treatment and intracranial haemorrhage within 24 hours.

Results: Of the 1233 enrolled patients, 1069 (86.7%) received SR alone first-line, and 164 (13.3%) received SR+CA first-line. SR+CA first-line was associated with more thrombectomy passes (3 (2-4) vs 2 (1-2); β=1.77, 95% CI=1.55 to 1.99, p<0.001), and longer procedure duration (86 (60-129) min vs 80 (50-122) min; β=10.76, 95% CI=1.08 to 20.43, p=0.029) than SR alone first-line group. Other outcomes were comparable (all p>0.05) between the two groups.

Conclusions: Patients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone first-line. Additionally, we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level, first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.

背景和目的:对ASTER 2试验的分析显示,在急性大血管闭塞(LVO)卒中中,支架取出(SR)单独作为一线机械血栓切除术(MT)技术(SR单独作为一线)和同时使用接触抽吸(CA)加SR作为一线MT技术(SR+CA一线)的最终再通水平和临床结果相似。本研究的目的是比较SR+CA一线和单独SR一线治疗中国LVO患者的安全性和有效性。方法:我们使用ANGEL-ACT注册中心的数据进行本研究。我们将选定的患者分为SR+CA一线组和单纯SR一线组。我们进行了逻辑回归和广义线性模型,并对其进行了调整,以比较血管造影和临床结果,包括第一次单独技术和所有手术后成功/完全再通、第一次成功/完全复通、通过次数、90天改良Rankin量表、手术持续时间、抢救治疗和24小时内颅内出血 小时。结果:在1233名入选患者中,1069名(86.7%)接受了SR单独一线治疗,164名(13.3%)接受了SR+CA一线治疗。SR+CA一线与更多的血栓切除通过相关(3(2-4)vs 2(1-2);β=1.77,95%CI=1.55~1.99,p0.05)。结论:一线接受SR+CA的患者比单独一线接受SR的患者有更多的血栓切除通道和更长的手术时间。此外,我们认为,在中国人群中,SR+CA一线在最终再通管水平、首次再通管程度和90天临床结果方面并不优于单独的SR一线。
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引用次数: 3
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Stroke and Vascular Neurology
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